Holiday Gifts From Health Reform

This holiday season you may be surprised to find some gifts from the Affordable Care Act (aka health reform) in your stocking. I say "surprised" because a recent Kaiser Family Foundation poll found that the American public still doesn't know what is in the health reform law and what is not.

If you haven't been sick this year or are not included in the following categories of people who are benefiting from health reform, it makes sense that you won't have paid much attention. You may not experience concrete benefits until it is fully implemented in 2014. But just in case you know someone in these categories, here's the list of health reform "gifts" available this year (see my blog on the Health Insurance Resource Center for more details):

1. If you are 65 or older -- (and eligible for Medicare) -- seniors who are enrolled in Medicare Advantage plans (that's Part C or the managed care part of Medicare) may have seen their premiums reduced this year. Some may even have access to ZERO premium health plans. Seniors also now receive free preventive treatments and a rebate of $500 if their drug coverage hits the "donut hole" in 2011.

2. If you haven't turned 26 yet -- you may have been able to stay on your parents' health plan this year, even if you are working or don't live at home. 2.5 million young people had access to this benefit. And 90,000 children under the age of 19 could not be denied coverage because of a pre-existing condition due to a change that was implemented in 2011.

3. If you needed preventive care (or had the good sense to get it) -- you had access to it this year without a co-payment or deductibles.

4. If you were a small business owner -- with fewer than 25 employees and average wages of $50,000 a year, you were eligible for a substantial tax credit if you offered health insurance coverage to your workers.

5.If you have been uninsured for 6 months because you couldn't afford coverage or had a serious medical condition -- you could enroll in your state's "pre-existing condition insurance pool" and get coverage at a more reasonable rate. (Read this story about a woman who had criticized Obama for the health care law but then got cancer, apologized to Obama publicly because she was able to find coverage from her state's high risk pool.)

6. If you did accrue substantial medical bills this year, the law restricts annual limits on health insurance coverage.

7. And if you are an individual who buys insurance on your own, not through an employer -- you know how hard it is to get that coverage and how expensive it can be. But one of the benefits of health reform identified by only 38 percent of the Kaiser poll respondents is something called the "medical loss ratio". The MLR requires that health plans pay out at least 80 percent of your premium for actual medical care (85 percent if it's a large plan). That is, they can only spend 20 percent of your premium on advertising and other administrative costs. If they do not spend at least 80 percent on medical care, they have to pay a rebate to you, the consumer, most likely in the form of a reduced premium. I mention the individual buyer of coverage here, because most insurers who offer plans through the group market (small or large) likely meet those 80 percent requirements today. It is the insurer who markets to individuals that may be failing to meet the 80 percent requirement. We can thank HHS for holding the line on the MLR regulations to the benefit of the rest of us. The MLR may be one of the best holiday gifts of all.

Did you already know most of this? Congratulations, but you are in the minority. The Kaiser poll also found that the majority of respondents had heard very little from the media about health reform in the past thirty days, other than what is being said in the Republican debates. In the midst of a great amount of doom and gloom over the economy, and constant attacks on the president and the Affordable Care Act, it's important to remember that some good things have been done for the most vulnerable of our friends and family. Pass it along!